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508                                              MEDICAL JURISPRUDENCE

Occasionally the toxic symptoms may not appear immediately after the
intravenous administration of the drug, but may "be delayed for some weeks
and death may occur from acute yellow atrophy of the liver. Policard and
Pinard u cite a case of syphilis in a man, aged 28 years, who, fifty days after
three doses equivalent to 1.05 gramme of neosalvarsan, developed acute
yellow atrophy of the liver and died in six days.

Fatal Dose and Fatal Period.—According to Holland15 10.5 grammes of
salvarsan might cause death. Medicinal doses have, however, caused death.
A dose of 0.5 gramme of salvarsan injected intravenously caused the death
of a Kashmiri Mahomedan, aged 20 years, in 25 hours.10 A woman, 42 years
old, suffering from Addison's disease, died in 12 hours after an intravenous
injection of 0.15 gramme of neosalvarsan.17 A male, aged 50 years, who was
suffering from asthma, died within half an hour of receiving an intravenous
injection of 0.6 gramme of neosalvarsan.18

Treatment.—Inject adrenaline hydrochloride hypodermically before or
after the injection to ward off the symptoms of an anaphylactic nature. Give
intravenous or rectal injections of normal saline as well as hyper tonic
solutions of sodium chloride and sodium bicarbonate to render the blood
alkaline and to eliminate arsenic from the system. Inject intravenously
sodium thiosulphate in doses of 0.45, 0.6 and 0,9 gramme dissolved in 5 cc.
of water on alternate days and 25 ml. of a 25 per cent solution of dextrose
on each of the intervening days for the treatment of exfoliative dermatitis.
Give also liver extract and ascorbic acid. Administer intravenously 25 to
50 ml. of a 25 per cent solution of glucose for the treatment of jaundice.
Inject intravenously 10 cc. of a 5 per cent solution of sodium deKydrocholate
mixed with neosalvarsan to combat its toxic action on the liver.

B.A.L. has been recently recommended in the treatment of dermatitis
and other complications arising in the course of arseno-therapy. Two millili-
tres of a solution containing 10 per cent B.A.L. and 20 per cent benzyl
benzoate in arachis oil should be injected intramuscularly into the thigh or
gluteal region.

Post-mortem Appearances.—Cloudy swelling or fatty degeneration of
the liver, kidneys and heart may be present. Acute encephalitis with
haemorrhagic spots in the brain may be found.

Chemical Tests.—1. Ammonio-nitrate of silver produces a yellow preci-
pitate of arsenite of silver in an arsenious acid solution.

2.    Ammonio-sulphate  of  copper  gives   a  bright  green  precipitate  of
arsenite of copper (Scheele's green).

3.    Reinsch's Test.—This is a very delicate test,, and arseniq, may be
readily detected to the extent of 1 : 1,000,000 and 1 : 7,000,000 if the solution
is concentrated.   The method of procedure is as follows: —

Drop one or two strips of bright copper foil into the suspected solution
previously acidulated with pure hydrochloric acid and boil it for five to ten
minutes, when the copper foil is coated steel-grey or black with a deposit of
arsenic, if present. The foil is then removed, washed successively in distilled
water, alcohol and ether, dried on filter paper and then heated by placing it
in a small test tube. The deposit, if due to arsenic, volatilizes and forms a
white deposit further up in the cooler portions of the tube. This deposit,

14.    Presse Medicate, Jan. 8, 1921, p. 42 ; Peterson, Haines and Webster, Leg. Med. and
Toxic., VoL n, Ed. H, p. 258.

15.   Med. Cherrt. and Toxic., p. 288.

16.   Neve, Ind. Med. Gaz.t Jan. 1915, p. 20.

17.   Hellfors,  Medizinische  Klinik,  Berlin,  Jan.  20,  1933,  p.   117;   Jour.  Amer.  Med.
Assoc., March 18, 1933, p. 860.

18.   C. C. Mahadeva, Ind. Med. Gaz., Feb. 1943, p. 126.